Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 089996 | OH |
NPI | 1326127283 |
---|---|
Provider Name | Dr. Srinivas Erragolla |
First Address | Beavercreek, OH 45430-1762 |
Second Address | Dayton, OH 45417-3445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 24/10/2020 |